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Toronto researchers test new rehabilitation method for paralyzed patients – The Globe and Mail



The field of brain-machine interfaces has taken off in recent years, with Silicon Valley leaders joining the fray. Companies such as Facebook and Elon Musk’s Neuralink envision we will one day be able to use this type of technology to control our laptops and smartphones with our thoughts.

In Toronto, Cesar Marquez-Chin has a very different idea for the use of brain-machine interfaces, which use brain signals to communicate with electronic devices. He is among a small number of international researchers using a relatively low-tech form of this technology to help train people paralyzed by stroke or spinal-cord injury to move again.

Dr. Marquez-Chin, a scientist at the Toronto Rehabilitation Institute’s research arm KITE (Knowledge, Innovation, Talent, Everywhere), is testing the use of a non-invasive brain-machine interface to enhance an increasingly common rehabilitation technique called functional electrical stimulation.

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Functional electrical stimulation (FES) delivers electric impulses to specific muscles, causing them to contract. For individuals who have experienced stroke or spinal-cord injury, therapists apply FES to the paralyzed body part, with the aim of retraining movement over many sessions. But for reasons that are not yet entirely understood, the technique does not work for everyone.

Dr. Marquez-Chin says he believes this is where the brain-machine interface comes in. With a single electrode placed on the skull, the patient’s own brain signals control when the electrical impulse is delivered to the paralyzed body part. This then bridges the patient’s intention to move with the action of moving, he said.

So far he has completed tests of the approach on two research participants, a tiny sample among the roughly 86,000 Canadians living with a spinal-cord injury and around 400,000 others living with long-term disability from stroke. But both participants, who had severe chronic hemiplegia, or paralysis on one side of their body after a stroke six years prior, regained much of the voluntary movement in their hands and arms after 40 and 80 sessions respectively. Neither had improved with earlier attempts using FES therapy alone.

His results mirror those of researchers elsewhere. A small number of studies using similar brain activity-controlled FES by researchers in other parts of the world, including in Switzerland, Japan and the U.S., have also shown participants have regained movement after repeated training.

Milos Popovic, KITE director and collaborator of Dr. Marquez-Chin, calls it an “exciting” approach, and while their research is in its infancy, his team’s initial results suggest they are on the right track. “Patients are doing absolutely outstanding,” he said.

The Toronto researchers published a case study of their first participant in the journal Case Reports in Neurological Medicine in 2016. They published their second case study in the American Journal of Physical Medicine and Rehabilitation in early 2019.

Dr. Marquez-Chin is now conducting a follow-up study, testing the approach on eight individuals with tetraplegia, or paralysis from the neck down, due to spinal-cord injury. In a presentation at the University Health Network’s CRANIA Conference in September, he showed videos of two participants, whose identities are protected, initially unable to make a fist or lift their arm. After 27 sessions, one participant, who had a spinal-cord injury two years prior, was shown lifting a bottle of water to his lips. The other, who had a stroke six years earlier, was able to put on his hat.

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Brain-machine interfaces are not without controversy. Some, such as Suzanne Rivera, an associate professor of bioethics at Case Western Reserve University in Cleveland, caution there are numerous ethical considerations for testing this type of technology, including questions about the physical risks involved, as well as risks to participants’ dignity and privacy that might arise, for example, if a device is hacked.

Moreover, she said in an e-mail, “If participants benefit from the experimental device, what are the plans to make it available to them once the trial is over?”

Compared with the brain-machine interfaces proposed by the likes Facebook and Neuralink, those used by Dr. Marquez-Chin and his peers are less sophisticated, and patients are hooked up to the technology for only as long as their rehabilitation sessions. Even so, the researchers still have a lot more work to do before the use of brain-machine interfaces with FES is widely adopted. For example, they have yet to figure out the ideal duration and number of sessions, whether there are side effects, which patients might benefit most and how the intervention compares with current therapies.

“This isn’t something that can go out and be widespread today or tomorrow,” said Patrice Lindsay, Heart & Stroke’s director of systems change and stroke program. “It’s great if we can go there with it, [but] I think there’s a lot we still have to learn about how it works [and] which patients are the right patients.”

Nevertheless, the early results reflect a shift in thinking about rehabilitation for those with chronic paralysis. Previously, it was widely believed recovery was impossible once the initial period after a stroke or spinal-cord injury had passed, Dr. Marquez-Chin said. Now, it appears it’s not too late, even years later, to see improvements.

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Get COVID-19 and flu shot at the same time – Windsor Star



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You can get a COVID-19 vaccination and annual flu shot at the same time, Windsor Essex County Health Unit director of health protection Kristy McBeth said Thursday.

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The National Advisory Committee on Immunization, which makes recommendations on the use of vaccines in Canada, recommended recently that the COVID-19 vaccine can be administered at the same time or any time before or after other vaccines, including the flu shot.

Previously, the committee had recommended that COVID-19 vaccines be administered at least 28 days before or 14 days after other shots as a precautionary measure.

After reviewing the evolving evidence on COVID-19 vaccines and considering the extensive data on administering other routine vaccines at the same time or within days of each other, the committee has determined that the earlier, precautionary approach is no longer necessary.

The new recommendation is expected to help the rollout of the flu shot this fall as well as make it easier for people to get  other vaccines they may have missed during the pandemic.

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The flu shot is free in Ontario and available at doctors’ offices and pharmacies. Hospitals, long-term care homes, doctors’ offices, walk-in clinics and pharmacies here have already received their supplies.

People over age 65 and those at risk of complications from flu have been given priority and are receiving the vaccine now. The shot will be available to the general public in November.

The health unit will begin promoting the shot more widely next month.

“We will be doing some extra promotion, urging people to get it,” McBeth told the health unit’s board of directors.

Between 150,000 and 200,000 doses are expected to be administered here this season, up from 97,000 last year.

Ontario has ordered 7.6 million doses this year, 1.4 million more than last year, Health Minister Christine Elliott said Tuesday.

There were few cases of flu last season because many people worked from home, their children learned remotely and the economy and society were locked down.

But more cases are expected this season because many people have returned to offices, schools have reopened and many restrictions have been lifted, allowing people to be out in the community more and to socialize and travel.

People are being urged to get the flu shot to avoid overwhelming hospitals that are still caring for COVID-19 patients.

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Canada scraps COVID-19 travel advisory; Ontario to end mask, vaccine rules by March



Canada has scrapped an official advisory urging its citizens to shun  non-essential foreign travel, given its successful campaign to inoculate people against COVID-19, the country’s top medical officer said on Friday.

Hours later, Canada’s most populous province, Ontario, issued a timeline to lift all remaining COVID-19 restrictions, with the aim of removing all proof of vaccination and mask requirements by March 2022.

Canada’s travel warning was issued in March 2020, when the COVID-19 pandemic erupted.

Ottawa removed the advice to avoid unnecessary travel late on Thursday, however it is still telling people to avoid cruise ship travel outside of the country.

“The beginnings of the transition away from the more blanket approach really recognizes vaccines are very effective at preventing severe outcome,” Chief Medical Officer Theresa Tam told a briefing.

According to official data, just under 82% of eligible Canadians had been fully vaccinated against COVID-19 by Oct 8.

Tam said the latest surveillance data showed “a continued decline in disease activity nationally and in most jurisdictions.”

“Now is not the time to just freely go wherever,” she added, citing high cases of coronavirus in some nations.

Ontario laid out a six-month timeline to lift all COVID-19 restrictions, starting with removing capacity limits in the “vast majority” of public venues on Oct. 25, and culminating in an end to all mask and proof of vaccination requirements by March.

The timeline will be dependent on “the absence of concerning (pandemic) trends,” it said in a statement.

“This plan is built for the long term,” Premier Doug Ford said. “It will guide us safely through the winter and out of this pandemic, while avoiding lockdowns and ensuring we don’t lose the hard-fought gains we have made.”

Ontario spent much of the past 18 months in some form of  lockdown due to high infection rates and hospital bed occupancy of COVID-19 patients.

(Reporting by David Ljunggren in Ottawa and Moira Warburton in Vancouver; Editing by Paul Simao and Bill Berkrot)

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COVID-19 vaccines not linked to pregnancy loss; mixing vaccines may confer greater protection



The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that have yet to be certified by peer review.

COVID-19 vaccines not linked with pregnancy loss

Two studies in major medical journals add to evidence that COVID-19 vaccines are safe before and during pregnancy. One study, published in The New England Journal of Medicine on Wednesday, tracked nearly 18,500 pregnant women in Norway, including about 4,500 who had miscarriages. Researchers found no link between COVID-19 vaccines and risk of first-trimester miscarriage, regardless of whether the vaccines were from Moderna, Pfizer and BioNTech, or AstraZeneca. Overall, the women with miscarriages were 9% less likely to have been vaccinated, according to the researchers’ calculations. In a separate study published on Thursday in The Lancet, researchers tracked 107 women who became pregnant while participating in trials of AstraZeneca’s vaccine in the UK, Brazil and South Africa. Seventy-two of the women had received the vaccine while the others got a placebo. AstraZeneca’s vaccine had no effect on the odds of safely carrying the pregnancy to term, the researchers reported. “It is important that pregnant women are vaccinated since they have a higher risk of hospitalizations and COVID-19-complications, and their infants are at higher risk of being born too early,” the authors of the Norwegian study wrote. “Also, vaccination during pregnancy is likely to provide protection to the newborn infant against COVID-19 infection in the first months after birth.”

Vaccine combinations with different technologies may be best

Healthcare workers in France who got a first shot of AstraZeneca’s COVID-19 vaccine and then the Pfizer/BioNTech vaccine for their second shot showed stronger immune responses than those who had received two shots of the Pfizer vaccine, in a recent study. Combining different technologies is known to boost immune responses to other viruses, and the current study suggests it may be true for the coronavirus as well. Both vaccines in the study deliver instructions that teach cells in the body to make a piece of protein that resembles the spike on the coronavirus and that triggers an immune response. But they do it in very different ways. Both protocols provided “safe and efficient” protection, said Vincent Legros of Universite de Lyon in France, coauthor of a report published on Thursday in Nature. But combining the AstraZeneca shot with the Pfizer/BioNTech vaccine “conferred even better protection” than two doses of Pfizer’s shot, including against the Delta variant, Legros said. The two technologies combined induced an antibody response of better quality, with more neutralizing antibodies that could block the virus, and more cells that have been “trained” by the vaccine to have increased defense potential, he said. Combination vaccination “is safe and may provide interesting options… for clinicians to prevent SARS-CoV-2 infection,” Legros concluded.

Cognitive problems seen in middle-aged COVID-19 survivors

A “substantial proportion” of middle-aged COVID-19 survivors with no previous dementia had cognitive problems more than half a year after diagnosis, researchers have found. They looked at 740 people who ranged in age from 38 to 59. About half were white, and 63% were female. On tests of thinking skills, 20% had trouble converting short-term memories to long-term memories, 18% had trouble processing information rapidly, and 16% had trouble with skills needed for planning, focusing attention, remembering instructions, and juggling multiple tasks. The average time from diagnosis was 7.6 months. About one-in-four patients had been hospitalized, but most of them were not critically ill. “We can’t exactly say that the cognitive issues were lasting because we can’t determine when they began,” said Dr. Jacqueline Becker of the Icahn School of Medicine at Mount Sinai in New York City, who co-led the study published on Friday in JAMA Network Open. “But we can say that our cohort had higher than anticipated frequency of cognitive impairment” given that they were relatively young and healthy, Becker said.

Data support use of Pfizer vaccine in children and teens

The Pfizer/BioNTech COVID-19 vaccine showed 90.7% efficacy against the coronavirus in a trial of children ages 5 to 11, the U.S. drugmaker said on Friday in briefing documents submitted to the U.S. Food and Drug Administration but not formally published. The children were given two shots of a 10-microgram dose of the vaccine – a third of the strength given to people 12 and older. The study was not primarily designed to measure efficacy against the virus. Instead, it compared the amount of neutralizing antibodies induced by the vaccine in the children to the response of recipients in their adult trial. Pfizer and BioNTech said the vaccine induced a robust immune response in the children. Outside advisers to the FDA are scheduled to meet on Tuesday to vote on whether to recommend authorization of the vaccine for that age group. A separate study from Israel conducted while the Delta variant was prevalent and published on Wednesday in The New England Journal of Medicine, compared nearly 95,000 12- to -18-year-olds who had received Pfizer’s vaccine with an equal number of adolescents who had not been vaccinated. The results show the vaccine “was highly effective in the first few weeks after vaccination against both documented infection and symptomatic COVID-19 with the Delta variant” in this age group, the research team reported.

Click for a Reuters graphic on vaccines in development.


(Reporting by Nancy Lapid; Additional reporting by Michael Erman; Editing by Bill Berkrot)

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